PSYC251 Lecture 3

Today's Agenda

Behavioural Problems in Children and Adolescents
Developmental Disorders- ADHD (Attention Deficit Hyperactivity Disorder)
- Autism
Consultation on Addiction and Smart Recovery

Behavioural Problems in Children and Adolescents

Conduct Disorder (CD)

Definition: Conduct Disorder is characterized by a persistent pattern of behavior where the basic rights of others or major age-appropriate societal norms and rules are violated. Children exhibiting this disorder display a broad range of behaviors that result in conflict with their environment.

Oppositional Defiant Disorder (ODD)

Definition: Oppositional Defiant Disorder is recognized as a pattern of negative, aggressive, and defiant behaviors that do not involve the serious violations of basic rights that are typical of Conduct Disorder.

DSM V Conduct Disorder Criteria

Criteria: - A repetitive and persistent pattern of behavior where basic rights of others or social norms are violated. At least $3$ out of $15$ criteria must be met:
1. Aggression to People and Animals:
  - Bullies, threatens, intimidates
  - Initiates physical fights
  - Uses a weapon to cause serious harm
  - Physically cruel to people or animals
  - Stolen while confronting a victim
  - Forced someone into sexual activity
2. Destruction of Property:
  - Fire setting
  - Destroyed property in other ways
3. Deceitfulness or Theft:
  - Broken into someone’s house, building, or car
  - Lies to others (cons)
4. Serious Violation of Rules:
  - Stays out at night without parental permission (before age $13$ )
  - Runs away from home overnight ( $2+$ times) or $1$ x for a lengthy time
  - Often truant from school (before age $13$ )
Criterion B: Clinically significant impairment in social, academic, or occupational functioning.
Criterion C: If over age $18$ , criteria for antisocial personality disorder are not met.

Adult Criminality and Childhood Animal Abuse

Felthous & Kellert Studies: A strong link was found between acts of cruelty to animals in childhood and serious aggression against people as adults. Most aggressive criminals committed severe acts of animal cruelty.
Ascione Findings:
- $48\%$ of individuals jailed for sexual homicide abused animals as children.
- $46\%$ of convicted rapists abused animals as children.

Oppositional Defiant Disorder (ODD) as a DSM V Diagnostic Category

Definition: ODD is defined as a repeated pattern of negative, defiant, disobedient, and hostile behavior toward authority figures, including:
- Frequent temper tantrums
- Arguing with authority figures
- Defiance
- Non-compliance
- Blaming others
- Vindictiveness

Specific DSM V ODD Criteria

Criteria: - A repeated pattern of negative, defiant, disobedient, and hostile behavior toward authority figures lasting more than $6$ months. Three subtypes:
1. Angry/Irritable Mood: Tendency to lose temper, easily annoyed, angry, and resentful.
2. Argumentative/Defiant Behavior: Regularly argues with authority figures and deliberately annoys others.
3. Vindictiveness: Spiteful or revengeful behavior at least twice within the last $6$ months.
Criterion B: Clinically significant impairment or distress.
Criterion C: To make sure it's not actually another mental health condition like psychosis, depression, bipolar disorder, or substance use.

Severity of ODD

Severity Levels:
- Mild: Symptoms confined to $1$ setting.
- Moderate: Symptoms present in at least $2$ settings.
- Severe: Symptoms evident in $3$ or more settings.
Impact on functioning: Symptoms cause clinically significant distress or impairment; they must not occur exclusively due to a mood or psychotic disorder, and the criteria for Conduct Disorder must not be met.

Causes and Risk Factors of Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD)

Genetic Factors: Inattention, hyperactivity, aggressiveness, and novelty seeking may have genetic contributions.
Temperament: How the child’s natural personality (temperament) interacts with family dynamics is important.
Environmental Factors: Include a history of exposure to violence, substance abuse, and a family history of ADHD or CD.
Risk Factors for CD:
- Parent with mood or substance abuse disorder
- Abuse or neglect in childhood
- Harsh or inconsistent discipline
- Lack of parental supervision
- Poor relationships with parents
- Family instability, financial problems, or frequent relocations.

Correlation with Deviant Peer Groups and Outcome of Conduct Disorder

Earlier Onset: Starting early usually means more serious problems. The younger the child, the worse the problems.
Causal Wheel: Factors influencing bad behavior (delinquency) and antisocial actions include:
- Membership in deviant peer groups
- Rejection from peers
- Parental rejection
- Low self-esteem
- Academic failure
- Ineffective discipline.

Treatment Options for Oppositional Defiant Disorder (ODD)

Parent Management Training Programs: Educate parents to better manage the child's behavior.
Individual Therapy: Programs focused on anger management.
Family Therapy: Addressing problems within family dynamics.
Cognitive Problem-Solving Skills Training: Helping the child get better at solving problems.
Social Skills Training: To improve social skills and frustration tolerance.
Medication: Treat other conditions that happen at the same time, like ADHD or anxiety.

Prevalence and Gender Differences in Conduct Disorder (CD) and ODD

Prevalence Rates:
- $2\%-$ - $6\%$ for CD
- $12\%$ for ODD
Gender Differences: Antisocial behavior is $3$ - $4$ times more common in boys during childhood, with differences decreasing or disappearing by age $15$ . Boys generally show more violence, while girls may use more indirect forms of aggression.

Relationship Between ODD and CD

The link between ODD and CD is unclear; while ODD can be something that leads to CD, this is not always the case. Both disorders may stem from difficulties in a person's ability to manage their emotions and behaviors. This is influenced by many biological, psychological, and social factors such as economic hardship, unhelpful parenting, and unstable family life.

School Violence

Modern Phenomenon: A significant number of school shootings have been recorded from $1966$ to $2007$ . Review Panel findings report $45$ school shootings during this period. A large number of shooters experienced bullying and retaliation.

Warning Signs Associated with Shooters

Violent fantasy content
Anger problems
Fascination with weapons
Fighting behaviors
Loneliness or social withdrawal
Thoughts about suicide
Thoughts about killing others
Stalking behavior
Disciplinary problems
Admiration for other murderers
Interest in prior shooting events.

Preventing School Violence

Parental Interventions: Encourage good social behavior, eliminate access to firearms, and promote healthy activities.
School Strategies:
- Identify at-risk children.
- Teach conflict resolution skills.
- Establish clear rule structures.

Parenting Styles

Types:
- Permissive: High responsiveness but low demandingness (parents are warm but don't set many rules).
- Authoritarian: Low responsiveness and high demandingness (parents set many rules but are not very warm).
- Authoritative: High responsiveness and high demandingness (parents are warm and set clear rules).

Outcomes of Parenting Styles

Authoritarian Style:
- Problems in self-confidence, competence, and social abilities.
- Involvement in bad peer groups.
- Increased likelihood of inner emotional problems.
Permissive Style:
- Higher frequencies of conduct problems and lack of interest in school.
- Poor understanding of how to solve problems and social rules; positive peer influence can lessen some of the bad effects.
Authoritative Style:
- Children show better adjustment and skills.
- Higher levels of achievement and decreased likelihood of problem behavior.
- Strengthens resilience against risks.

Authoritative Parenting Insights

The positive results linked to authoritative parenting suggest it is often not universally practiced due to:
- Requirement of learned skills and time commitment.
- Emotional and relational impacts of trauma can harm parenting abilities.

Trauma and Parenting

Challenges for Traumatized Parents:
- Difficulty managing emotions and planning/organizing skills needed for raising children.
- Increased risk of aggressive responses due to fight/flight/freeze responses being triggered.

Concept of Behaviour Management

Purpose:
- Safety of children
- Building relationships
- Helping with learning and managing emotions
- Teaching social rules and respect for others.
- Building trust through setting limits.

Roles in Setting Limits

Adult Roles: Setting rules, helping children follow rules, and applying appropriate consequences for learning.
Child Roles: Helping make rules and following them.

Differences Between Behaviour Management and Punishment

Good Discipline: Focuses on teaching rather than punishment.
Punishment Includes: Physical pain, humiliation, isolation, revenge, or threats which can damage relationships.

Effective Limit Setting Characteristics

Reasonable limits create a secure environment for children. Unreasonable limits can lead to resistance and unhelpful behaviors.

Structural Family Therapy Overview

Hierarchy Importance: Adults should have the main authority in families; an inverted hierarchy means children have too much control, which points to family dysfunction.
Remediation of Dysfunctional Hierarchies: Instructing parents about their rights to assert authority without aggression.

Developmental Disorders Overview

Characteristics: Diagnosed in infancy, childhood, or adolescence resulting in major problems in how they function. Common disorders include ADHD and Autism.

Pervasive Developmental Disorders (PDD)

Definition: Disorders affecting language, socialization, and thinking over a person’s lifetime. Examples include:
- Autistic Disorder
- Asperger Syndrome
Viewed as related disorders on a spectrum.

Understanding Autism

Definition of Autism: A brain disorder affecting social interaction, communication, and behavior, emerging within the first $3$ years of life.
Key Characteristics: A range of functioning, problems with communication, very narrow interests, and difficulty in social relationships.

Triad of Impairments in Autism

1. Social Relationships: Not caring much about others and avoiding them.
2. Communication: Lack of back-and-forth communication.
3. Imaginative Play: Can't pretend play and struggle to understand other people's thoughts and feelings (Theory of Mind).

Autism Facts and Statistics

Prevalence: Affects $2$ to $20$ out of $10,000$ individuals.
Intellectual Functioning: $50\%$ of individuals may fall within the significantly low IQ range.

Common Traits in Autism

Difficulty in social interaction, problems with communication without words (like body language), changing reactions to things they experience, and a tendency to engage in repetitive behaviors.

Asperger's Syndrome

Similar to autism but does not generally involve major thinking problems. Typically diagnosed later because the symptoms are not as obvious or serious.

Signs of Asperger Syndrome

Difficulty in social interactions, communicating nonverbally, obsessive interests, and resistance to change in routines.

Prevalence of Asperger Syndrome

Estimates of prevalence are between $1$ to $2$ per $10,000$ , with likely genetic components shared with autism.

Understanding Normal Behaviors vs. Autism Symptoms

Note that while many behaviors may seem normal in children, persistent and very harmful effects distinguish autism or Asperger’s syndrome.

Cluster of Symptoms in Toddlers Garnering Concern

Lack of pointing by age $1$ , absence of babbling by age $1$ , no single words by $16$ months, loss of language skills, absence of pretend play, lack of response to name, not caring, and more.

Causes of Autism

Historical views blamed parenting; current understanding involves both genetic and environmental factors. Specific genes are being investigated.

Findings on Brain Development and Autism

Infants exhibiting rapid head growth may be at higher risk for developing autism symptoms. Genetic factors linked to problems with how the brain is built.

Neurobiological Findings

Explore unusual brain regions, how sensitive the cerebellum (a brain part) is to incoming information, damage to the amygdala (a brain part) causing problems with controlling emotions, and effects of hormones (like oxytocin, which helps with social understanding).

ADHD Overview

Definition: Characterized by inattention, overactivity, and impulsivity leading to behavioral, thinking, social, and academic challenges.
Diagnosis: Symptoms must meet specific criteria from the DSM.

Symptoms of ADHD by Clusters

Inattention: Failing to give close attention to details, difficulty staying focused, not listening, failing to follow through on tasks, and forgetfulness.
Hyperactivity: Fidgeting, inability to remain seated, running in inappropriate situations, and acting as if driven by a motor.
Impulsivity: Interruption of conversations, difficulty waiting turn, blurting answers prematurely.

ADHD Prevalence and Gender Differences

Prevalence ranges from $4\%-$ - $12\%$ in children aged $6$ to $12$ . Boys are diagnosed $4$ to $1$ compared to girls.

Assessment and Development of ADHD

Assessment comprises behavioral observations, IQ testing for learning disabilities, and behavioral assessments in school settings. Children show major problems with responsibilities as they age.

Biological Contributions to ADHD

Genetics: Evidence links family history to specific chromosomes.
Toxins: Lead exposure in early childhood increases risk.
Neurobiological Contributions: Less activity in certain brain parts like the frontal cortex and basal ganglia.

Treatments for ADHD

Biological Treatments: Focus on stimulant medications to reduce the main symptoms; however, such medications may have negative side effects.
Behavioral Treatments: Modifications in the classroom and at home, combining different strategies to manage symptoms effectively.

Final Examination Considerations

It is important to prepare for exam questions that compare and contrast the similarities and differences between Autism, Asperger's Syndrome, and ADHD.